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To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research designs. This said, there has been growing interest in incorporating qualitative research in guideline development processes from both stakeholders and guideline development bodies. In this international collaboration, 19 qualitative psychotherapy researchers from 10 countries articulated the benefits of including qualitative findings within the guideline development process and generated recommendations for guideline developers. The underlying question of this report was "Why and how should qualitative research be used in efforts to develop guidance for psychotherapy practice?" The advantages of reviewing qualitative findings included the ability to identify treatment patterns at the level of in-session dynamics, cultural contexts, interpersonal relationships, and internal experiences, thereby creating guidance that is responsive to clients' needs in the moment-to-moment therapy process. Recommendations are offered at the systemic level (e.g., guideline formation processes, methods of education, research funding priorities). Also, methodological advice is offered for guideline developers when selecting to incorporate qualitative research in the implementation of an expanded guideline development process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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This experimental study explored the use of online expressive writing interventions to cope with distress from heterosexist events among a sample of autistic-LBGQ + individuals. This study included an open writing condition and an emotion focused therapy guided writing condition. Over 89% of the participants indicated that the writing exercises were helpful in processing the event, with significant decreases for measures of depressive and trauma/stressor symptoms. A thematic analysis identified specific aspects of each condition that were helpful for participants in coping with heterosexist distress, such as the development of insight through the emotion-focused exercises. This low-demand exercise is promising as a solo exercise or as a therapy homework assignment, especially given the accessibility of this online intervention for autistic-LGBQ + people.

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Objective: The use of qualitative methods for investigating causation has been controversial ever since the "paradigm wars" of the 1980s. Quantitative and experimental researchers have largely dismissed the relevance of qualitative research for causal investigations, while many qualitative researchers have rejected the concept of causation entirely. However, a growing number of scholars, in both research methods and philosophy, have proposed an alternative perspective, one that sees quantitative and qualitative approaches as having complementary strengths and limitations in understanding causation. In this article, we consider this perspective in relation to the study of causality in psychotherapy research. Method: This paper reviews and integrates key descriptions of the mechanisms for identifying causal processes using qualitative research. Results: An overview of how qualitative methods study causation is presented, considering its implications for both identifying causality and for generalizing causal conclusions. Conclusion: The paper holds relevance for establishing outcomes caused by psychotherapy treatments and for developing clinical practice guidance for the field.

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There is research evidence, from both qualitative and quantitative studies, that silences in psychotherapy have established associations with good and poor outcomes that include and extend beyond symptom measures to processes such as insight, symbolization, and disengagement. Research also has demonstrated that therapists attend to clients' silences, seeking to comprehend the processes therein and intentionally support productive silent processes. This chapter synthesizes this research and examines features of silence processes to provide psychotherapists with the skills to differentiate the functions of both productive and obstructive forms of pausing. It includes a review of 33 quantitative and qualitative studies on silences in individual psychotherapy (from 309 clients and 209 therapists). Our qualitative and integrative meta-analytic evidence indicated that it enhanced their ability to intervene responsively and enhance therapy outcomes when psychotherapists' responded strategically to the specific functions of silences. We consider research limitations, training implications, and therapeutic practices based on the research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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Although research that documents minority stress caused to LGBTQ + people supports needed advocacy, it can concomitantly cause harm to communities by portraying them as depleted and powerless. This review article assesses if and how researchers who study minority stress also center interpersonal functions of gender expression that are agentic for trans/nonbinary (TNB) people. These functions were coded in the qualitative research related to minority stress for TNB people over the last five years. Findings revealed that while most interpersonal functions of gender were described rarely, especially those associated with TNB communities of color, damage-centered perspectives were common. Damage-centered perspectives were common. We charge the field to expand its scope of inquiry, center functionalist and agency-focused research, and to develop a multidimensional psychology of gender.

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Given the challenges to the notion of objectivity posed by social psychological research on investigator effects, constructivist and critical epistemological perspectives, and the introduction of qualitative research methods in psychology, the investigators examined how leading methodologists understand the function of objectivity and subjectivity in psychological science. The aim of the study was to learn how contemporary methodologists view these issues so as to communicate converging perspectives to the field and inform methods education. A brief historical review of the concept of objectivity in psychology is presented to contexualize this examination. Eleven accomplished methodologists with expertise in a range of methods and epistemological perspectives were interviewed. Findings from a grounded theory analysis demonstrated that all the participants expressed concern about the belief that science is unaffected by scientists' perspectives, believing researchers and educators should problematize this perspective. Recommendations from participants included that science be viewed as a value-laden endeavor in which scientists systematically conduct research from multiple epistemological perspectives, and/or utilize diverse methods tailored to address their questions. Scientific procedures were detailed that could curtail dangers of either unchecked subjectivity or a false sense of objectivity. A functional analysis of these constructs, objectivity and subjectivity, suggested they both serve a similar scientific and an ethical purpose-to prevent the premature foreclosure of possible understanding because of the expectations of researchers. The mainstreaming of disclosures about the perspectives and positions of investigators, as well as their management, and the implementation of epistemological and methodological pluralism are encouraged to support this ethic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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OBJECTIVE: : A growing body of empirical evidence suggests that psychotherapy is more effective when therapists tailor interventions to fit their specific clients' needs, a concept referred to as therapist responsiveness in the psychotherapy literature. However, the question of how therapists learn to become responsive rarely has been examined. METHOD: : The central question of this study, put to eleven graduate student therapist trainees, was, "How did you learn to be responsive to clients as a novice therapist, and in what ways have you become responsive?" A critical-constructivist grounded theory method was employed to generate themes from trainees' replies. RESULTS: : The analysis showed that trainees learned to improve their responsiveness to clients by: (1) becoming more aware of cues that signaled the need to adapt interventions (as related to psychotherapy change processes, client-therapist relational dynamics, clients' identities and cultural contexts, and the maximizing of clients' agency); (2) developing attunement to their own emotions and engaging in self-care; and (3) adopting mindsets that facilitated their trying new relational or therapy approaches while also maintaining professionalism. CONCLUSION: Based upon these findings, preliminary suggestions for responsiveness training are presented to guide programs that wish to train responsive psychotherapists .

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This article articulates principles and practices that support methodological integrity in relation to critical qualitative research. We begin by describing 2 changes that have occurred in psychological methods over the last 15 years. (a) Building on foundational work advocating for epistemological pluralism, guidelines on how to design, review, and report qualitative and mixed methods have been advanced to support methodological integrity in keeping with a diversity of researchers' aims and approaches. (b) There has been an increased use of critical epistemological perspectives and critical methods. In light of these changes, the current article puts forward principles to support critical qualitative researchers when considering methodological rigor and when formulating rationales to support their methods in the journal article review process. Illustrating the principles with an example of critical research, the article describes common problems and issues in the research design process that can be considered in order to strengthen the returns of critical studies. Recommendations are made for editors and reviewers on how to conduct reviews of critical qualitative research, and pressing concerns for publishing critical qualitative research are detailed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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Quite a number of heated arguments have been put forth in the controversy about the meanings and appropriate uses of femme identities. In this article, the authors apply a functionalist theoretical framework, developed to explicate the links between gender and gender identities, to reframe the disputes about femme gender. They position two femme identities as responding to distinctive forms of oppression-one that centralizes the affirmation of gender diversity in the face of cisgenderism, and one that centralizes lesbian, gay, bisexual, transgender, and queer (LGBTQ+) femininity to counter femmephobia. They consider the subversive functions of the two identities in terms of unmet needs across four domains. These needs include the need for authenticity in identity (psychological domain); for the prizing of socially devalued characteristics (cultural domain); for security and affiliation (interpersonal domain); and for aesthetic desirability rather than shame (sexual domain). Instead of seeing the two femme identities as at odds, they see them as serving some shared functions, but also distinctive functions in resisting stigma of varied forms. The framework can be applied to other forms of femme-inity (and other genders) to distinguish the varied meanings inherent in gender identities and facilitate research that advances gender theory.

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Expressive writing exercises, in which participants self-reflect upon a difficult experience, are widely researched interventions. These exercises have been adapted to address a host of concerns, including trauma, mental distress, physical health, and minority stress. Although several theories exist about the mechanisms through which expressive writing yields psychological benefits, the direct perspectives of those who have completed expressive writing exercise has remained unexplored. This study used grounded theory methods to analyze sexual minority adults' interviews about their experience of engaging in various formats of expressive writing exercises about personal heterosexist events. Participants described both what they found helpful and frustrating about the writing process and reflected on how their perspectives shifted throughout the process. These findings contribute to the literature on how change occurs in expressive writing and provide guidance on how to assist sexual minority adults in healing from heterosexism in their lives.

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Although qualitative research has long been of interest in the field of psychology, meta-analyses of qualitative literatures (sometimes called meta-syntheses) are still quite rare. Like quantitative meta-analyses, these methods function to aggregate findings and identify patterns across primary studies, but their aims, procedures, and methodological considerations may vary. OBJECTIVE: This paper explains the function of qualitative meta-analyses and their methodological development. Recommendations have broad relevance but are framed with an eye toward their use in psychotherapy research. Rather than arguing for the adoption of any single meta-method, this paper advocates for considering how procedures can best be selected and adapted to enhance a meta-study's methodological integrity. METHOD: Through the paper, recommendations are provided to help researchers identify procedures that can best serve their studies' specific goals. Meta-analysts are encouraged to consider the methodological integrity of their studies in relation to central research processes, including identifying a set of primary research studies, transforming primary findings into initial units of data for a meta-analysis, developing categories or themes, and communicating findings. CONCLUSION: The paper provides guidance for researchers who desire to tailor meta-analytic methods to meet their particular goals while enhancing the rigor of their research.

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The American Psychological Association Publications and Communications Board Working Group on Journal Article Reporting Standards for Qualitative Research (JARS-Qual Working Group) was charged with examining the state of journal article reporting standards as they applied to qualitative research and with generating recommendations for standards that would be appropriate for a wide range of methods within the discipline of psychology. These standards describe what should be included in a research report to enable and facilitate the review process. This publication marks a historical moment-the first inclusion of qualitative research in APA Style, which is the basis of both the Publication Manual of the American Psychological Association (APA, 2010) and APA Style CENTRAL, an online program to support APA Style. In addition to the general JARS-Qual guidelines, the Working Group has developed standards for both qualitative meta-analysis and mixed methods research. The reporting standards were developed for psychological qualitative research but may hold utility for a broad range of social sciences. They honor a range of qualitative traditions, methods, and reporting styles. The Working Group was composed of a group of researchers with backgrounds in varying methods, research topics, and approaches to inquiry. In this article, they present these standards and their rationale, and they detail the ways that the standards differ from the quantitative research reporting standards. They describe how the standards can be used by authors in the process of writing qualitative research for submission as well as by reviewers and editors in the process of reviewing research. (PsycINFO Database Record

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A metamethod study is a qualitative meta-analysis focused upon the methods and procedures used in a given research domain. These studies are rare in psychological research. They permit both the documentation of the informal standards within a field of research and recommendations for future work in that area. This paper presents a metamethod analysis of a substantial body of qualitative research that focused on clients' experiences in psychotherapy (109 studies). This review examined the ways that methodological integrity has been established across qualitative research methods. It identified the numbers of participants recruited and the form of data collection used (e.g., semistructured interviews, diaries). As well, it examined the types of checks employed to increase methodological integrity, such as participant counts, saturation, reflexivity techniques, participant feedback, or consensus and auditing processes. Central findings indicated that the researchers quite flexibly integrated procedures associated with one method into studies using other methods in order to strengthen their rigor. It appeared normative to adjust procedures to advance methodological integrity. These findings encourage manuscript reviewers to assess the function of procedures within a study rather than to require researchers to adhere to the set of procedures associated with a method. In addition, when epistemological approaches were mentioned they were overwhelmingly constructivist in nature, despite the increasing use of procedures traditionally associated with objectivist perspectives. It is recommended that future researchers do more to explicitly describe the functions of their procedures so that they are coherently situated within the epistemological approaches in use. (PsycINFO Database Record

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Many gay, bisexual, and transgender (GBT) people of color (POC) join house and/or constructed family communities, which serve as support networks composed mostly of other non-biologically related GBT/POC. These networks can decrease or increase the risk of exposure to HIV via multiple mechanisms (e.g., providing informal sexual safety education versus stigmatizing family members with HIV, encouraging sexual safety practices versus unsafe escorting, teaching self-care versus substance use) but act to support family members in the face of social and economic hardship. Researchers interviewed ten members of these social networks in the Boston metro area of the US and produced a saturated grounded theory analysis to explore the role of gay family/house networks in HIV risk management. While network members utilized HIV prevention resources, interviewees described how their efficacy was related to the intentions of leadership and strength of kinship boundaries within their community, economic opportunities, and communication skills. Clinical and research implications are discussed.

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OBJECTIVE: The primary objective of this study is to engender an understanding of how therapists-in-training experience and cope with self-criticism in the context of their clinical training and therapy experiences. METHOD: In this study, trainees were interviewed about their experience of self-criticism related to psychotherapy practice and these interviews were subjected to a grounded theory analysis generating a core self-critical process. RESULTS: The analysis highlighted the vulnerability of self-criticism in therapists' training experiences, especially when they related to balancing the "expert" role while maintaining authentic interactions with their clients. The results also described ways in which self-criticism is mitigated by a sense of interpersonal safety and the provision of clinical freedom and flexibility in therapists' training. CONCLUSIONS: The implications for future psychotherapy research and clinical training within clinical training environments are discussed.

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OBJECTIVE: The current study examines how clinical wisdom develops and how it both is and can be influenced by professional training processes. In this way, the project is studying the intersection of developmental and systemic processes related to clinical wisdom. METHOD: Researchers analyzed the interviews of psychologists practicing in the USA and Canada who were nominated for their clinical wisdom by their peers. These interviews explored how graduate training and professionalization were thought to influence the development of clinical wisdom and were subjected to an adapted grounded theory analysis. RESULTS: The findings described both professional and personal disincentives toward developing wisdom, including the dangers of isolation. Therapists reported concerns about educational systems that rewarded quick answers instead of thoughtful questioning in processes of admittance, training, and accreditation. Findings emphasized the importance of teaching multiple psychotherapy orientations, critical self- and professional-reflection skills, and openly supporting graduate students' curiosities and continued professional engagement. CONCLUSIONS: Recommended principles for training are put forward for the development and evaluation of psychotherapy training programs that aim to foster clinical wisdom. These principles complement training models focused upon clinical competence by helping trainees to develop a foundation for clinical wisdom.

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PURPOSE: Research often erases the distinct experiences of bisexual and queer women through collapsing participants with lesbian or gay women. In addition, queer is often not included as a sexual orientation identity in research, therefore limiting the available information about how this group experiences minority stress. Given these limitations, we sought to compare groups, based on their sexual orientation identity, on experiences of minority stress and mental health to further understand between group differences that often go unaccounted for in research. METHODS: Participants (N = 249; age range 19-77; M = 38.43, SD = 12.98) completed an online survey exploring experiences of minority stress and mental health. RESULTS: We found that the group most at risk for encountering minority stressors depended on the specific stressor being examined. Queer and gay or lesbian women encountered greater victimization, discrimination, and expectations of discrimination than bisexual women. However, bisexual women had higher levels of identity concealment and internalized heterosexism than gay, lesbian, or queer women. While queer women tended to have fewer proximal stressors, they were similar to bisexual women in terms of psychological distress, with both groups scoring higher than gay or lesbian women. CONCLUSIONS: These results highlight the need to examine between group differences in future research. The experiences of minority stress appear to complexly relate to psychological distress in varying ways for different groups of women, with bisexual and queer women having the highest rates of psychological distress although they vary in the types of stressors that they encounter. In addition, the experiences of queer women were divergent from those of gay, lesbian, or bisexual women across many of the stressors, indicating that there is a need to further recognize this distinct group of women in future research.

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This article argues that psychotherapy practitioners and researchers should be informed by the substantive body of qualitative evidence that has been gathered to represent clients' own experiences of therapy. The current meta-analysis examined qualitative research studies analyzing clients' experiences within adult individual psychotherapy that appeared in English-language journals. This omnibus review integrates research from across psychotherapy approaches and qualitative methods, focusing on the cross-cutting question of how clients experience therapy. It utilized an innovative method in which 67 studies were subjected to a grounded theory meta-analysis in order to develop a hierarchy of data and then 42 additional studies were added into this hierarchy using a content meta-analytic method-summing to 109 studies in total. Findings highlight the critical psychotherapy experiences for clients, based upon robust findings across these research studies. Process-focused principles for practice are generated that can enrich therapists' understanding of their clients in key clinical decision-making moments. Based upon these findings, an agenda is suggested in which research is directed toward heightening therapists' understanding of clients and recognizing them as agents of change within sessions, supporting the client as self-healer paradigm. This research aims to improve therapists' sensitivity to clients' experiences and thus can expand therapists' attunement and intentionality in shaping interventions in accordance with whichever theoretical orientation is in use. The article advocates for the full integration of the qualitative literature in psychotherapy research in which variables are conceptualized in reference to an understanding of clients' experiences in sessions. (PsycINFO Database Record

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OBJECTIVE: This research study explores the concept of clinical wisdom. METHOD: Seventeen psychologists who were nominated multiple times by their peers as wise clinicians participated in an interview on clinical wisdom, analyzed using grounded-theory methods. RESULTS: Participants described clinical wisdom as accepting that the best answers to clients' problems often were not immediately accessible and instead using their sense of their clients, their theory of psychotherapy, and their own experiences of adversity, diversity, and intimate relationships to help clients explore the ambiguities and vulnerabilities they experienced to craft idiosyncratic answers. CONCLUSIONS: An understanding of clinical wisdom is put forward, characterized by markers and principles for practice, to guide therapy processes within therapists' intentionality and direct research on common factors.

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Gender variant (GV) children have a subjective sense of gender identity and/or preferences regarding clothing, activities, and/or playmates that are different from what is culturally normative for their biological sex. Despite increases in rates of GV children and their families presenting at clinics, there is little research on how raising a GV child affects the family as a whole or how families make decisions regarding their care. This study took an ecological-transactional framework to explore the question, "what is the experience of parents who raise a GV or transgender child?" Eight mothers and three fathers of GV male and female children (ages 5-13) referred through a GV support group participated in interviews. Transcripts were analyzed using an adaptation of grounded theory analysis. These parents attempted to pave the way to a nonstigmatized childhood for their GV child, typically through two pathways: rescuing the child from fear of stigma and hurt or accepting GV and advocating for a more tolerant world. Many participants used both pathways to different degrees or shifted paths over time, and the paths selected were related to parents' own understanding of GV and their experiences and backgrounds as well as characteristics of the children they were parenting and the communities they inhabited. Limitations, clinical implications, and future directions are discussed.

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